Provider Demographics
NPI:1386793347
Name:FERGUSON, DEBORAH LEE (OTR/L LICENSED OCCUP)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LEE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:OTR/L LICENSED OCCUP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8050 SW WARM SPRINGS RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062
Mailing Address - Country:US
Mailing Address - Phone:503-564-0565
Mailing Address - Fax:503-563-5281
Practice Address - Street 1:8050 SW WARM SPRINGS RD
Practice Address - Street 2:SUITE 130
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062
Practice Address - Country:US
Practice Address - Phone:503-564-0565
Practice Address - Fax:503-563-5281
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR606012225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8411086Medicaid
OR275483Medicaid